Summary: Miss X complained that a Trust and Council mistakenly detained her under section 2 of the Mental Health Act and did not inform her family or an advocate on her behalf. She has said this caused her strain and distress. We will not investigate this complaint as there is insufficient evidence of fault by the organisations.

The complaint

1. Miss X has complained about North Lincolnshire Council (the Council) and Rotherham Doncaster and South Humber NHS Foundation Trust (the Trust) regarding her detention under the Mental Health Act in 2022.
2. Specifically, Miss X has complained:

• she was not given an advocate nor was her family informed; and
• she was detained despite her records showing her condition was improving.

3. Miss X said the experience was daunting and put a strain on her relationship
4. As a result of this complaint Miss X would like organisations, when considering whether to section someone, safeguarding practices to be put in place to protect vulnerable and disabled patients to ensure right outcome achieved.
5. She would also like people with mental health disorders to be treated with dignity and respect.

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The Ombudsmen’s role and powers

6. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

there is not sufficient evidence of fault on the part of the organisation, or

the fault has not caused injustice to the person who complained, or

the injustice is not significant enough to justify our involvement, or
(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

7. I considered evidence provided by Miss X and the organisations as well as relevant law, policy, guidance.
8. Miss X has an opportunity to comment on my draft decision. I will consider any comments before making a final decision.

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My assessment

Relevant legislation

9. Under the Mental Health Act 1983 (MHA), when someone has a mental disorder and is putting their safety or someone else’s at risk they can be detained in hospital against their wishes. This is sometimes known as ‘being sectioned’.
10. Usually three professionals need to agree that the person needs to be detained in hospital. These include an Approved Mental Health Professional (AMHP), working for the Council, and usually (but not always) two doctors who have been specially approved in Mental Health Act detentions (Section 12 doctors).
11. The AMHP is responsible for deciding whether to go ahead with the application to detain the person and for telling the person. Any admission should be in the best interests of the person, and they should not be detained if there is a less restrictive alternative.
12. When Section 12 doctors make recommendations under sections 2, 3 or 4 of the MHA, they are acting under powers which have been given to them under the MHA.
13. People who have been detained under the MHA can apply for a hearing to the First-Tier Tribunal (Mental Health) if they disagree with the decision. The Tribunal must discharge the person from detention if, on the day of the hearing, they do not meet the criteria needed for detention.
14. The MHA 1983 Code of Practice states that

‘14.4 A person can be detained for assessment under section 2 only if both the

following criteria apply:

the person is suffering from a mental disorder of a nature or degree which

warrants their detention in hospital for assessment (or for assessment

followed by treatment) for at least a limited period, and

the person ought to be so detained in the interests of their own health or

safety or with a view to the protection of others’

Background

15. In 2022, Miss X had been in hospital for several weeks with some medical issues.
16. Doctors became concerned Miss X had been refusing nutrition and medication as she was having delusions.
17. The AMHP and two Section 12 doctors carried out an MHA assessment. They recommended detaining Miss X under section 2 of the MHA.
18. Miss X complained about her detention, said she was not offered an advocate when she was sectioned, her family were not informed and she was getting better and so did not need to be detained.
19. The Trust admitted that although it filled out a referral for an advocate for Miss X, the advocate had no record of receiving it. The Trust had no record of sending the referral due to the time that had passed. It apologised for the situation and for Miss A’s experience.
20. In relation to the detention, the Trust said that Miss X’s refusal of nutrition and medication nearly led to her death. Although she had improved as she was starting to take nutrition and medication again, she still exhibited similar delusional thoughts to those that led to the original refusal. This needed further examination in a psychiatric ward and Miss X would not agree to this. This meant that the threshold for detention for assessment under the MHA was met.

Analysis

21. The records show that an AMHP and two section 12 doctors saw Miss X and noted their reasons for why it was necessary to go forward with the application to detain Miss X
22. The records also show that the doctors considered less restrictive measures, but Miss X had declined.
23. Therefore, it seems there is not enough evidence of fault in the application for detention for us to investigate.
24. Regarding the lack of an advocate the Trust has apologised for this apparent fault. However, her family appears to have been informed of the detention and her right to appeal the detention decision to a mental health tribunal.
25. Taking this into account there is not sufficient evidence for us to investigate Miss X’s detention. In addition, there seems to have been a fault in the Trust not making a referral to an advocate, but there is little evidence it led to an injustice for Miss X.
26. In addition, there is evidence in the records that Miss X’s nearest relative was informed of her detention and her right of appeal.

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Decision

27. We will not investigate this complaint as there does not appear to be sufficient evidence of fault leading to a significant injustice for Miss X.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman